Iranian Journal of Psychiatry 2018. 13(2):84-93.

Age at Onset and Social Cognitive Impairment in Clinically Stabilized Patients with Schizophrenia: An Ecological Cross-Sectional Study
Massimiliano Buoli, Alice Caldiroli, Marta Serati, Giulia Orsenigo, Elisabetta Caletti

Abstract


Objective: Purposes of the present study were to assess the social cognitive impairment in schizophrenia and to detect if some clinical variables (particularly age at onset) are predictive of general/social cognitive deficit in schizophrenia patients.

Method: Thirty-five clinically stabilized schizophrenia outpatients were assessed by the Brief Assessment of Cognition in Schizophrenia (BACS) and by Torralva’s social cognition battery. Binary logistic models were performed to find an eventual association between continuous clinical variables and cognitive test failures. The total sample was divided in groups according to dichotomous variables (gender, diagnostic subtypes and type of abuse) and the presence of cognitive deficits was compared between groups by χ2 tests.

Results: An earlier age at onset was found to be predictive of frontal cognitive impairment (Tower of London p=0.038, OR=0.702). Female gender was more probably associated with mistakes at MET-HV (χ2= 4.80, p=0.05, phi=0.40) and HOTEL tests (χ2= 5.25, p=0.04, phi=0.4) than male one. Cannabis abusers showed more frequently deficits on verbal fluency (χ2= 9.35, p=0.04, phi=0.52) and executive functioning (Tower of London) (χ2= 11.67, p=0.02, phi=0.58) than alcohol/cocaine ones.

Conclusion: Female patients with an early age at onset and cannabis abuse seem to have the worst general and social cognitive profile among patients suffering from schizophrenia

Keywords


schizophrenia; social cognition; age at onset; gender; cannabis abuse

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References


Bergh S, Hjorthøj C, Sørensen HJ, Fagerlund B, Austin S, Secher RG, Jepsen JR, Nordentoft M. Predictors and longitudinal course of cognitive functioning in schizophrenia spectrum disorders, 10 years after baseline: The OPUS study. Schizophr Res 2016; 175: 57-63.

Gur R. Neuropsychiatric aspects of schizophrenia. CNS Neurosci Ther 2011; 17: 45-51.

Heinrichs RW, Zakzanis KK. Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 1998; 12: 426-445.

Puig O, Penadés R, Baeza I, Sánchez-Gistau V, De la Serna E, Fonrodona L, Andrés-Perpiñá S, Bernardo M, Castro-Fornieles J. Processing speed and executive functions predict real-world everyday living skills in adolescents with early-onset schizophrenia. Eur Child Adolesc Psychiatry 2012; 21: 315-326.

Schaefer J, Giangrande E, Weinberger DR, Dickinson D. The global cognitive impairment in schizophrenia: consistent over decades and around the world. Schizophr Res 2013; 150: 42-50.

Tuulio-Henriksson A, Perälä J, Saarni SI, Isometsä E, Koskinen S, Lönnqvist J, Suvisaari J. Cognitive functioning in severe psychiatric disorders: a general population study. Eur. Arch. Psychiatry Clin Neurosci 2011; 261: 447-456.

Cornblatt B, Keilp J. Impaired attention, genetics, and the pathophysiology of schizophrenia. Schizophr Bull 1994; 20: 31-46.

Kuperberg G, Heckers S. Schizophrenia and cognitive function. Curr Opin Neurobiol 2000; 10: 205-210.

Green MF, Kern RS, Braff DL, Mintz J. Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the ‘right stuff’? Schizophr Bull 2000; 26: 119–136.

Green MF, Olivier B, Crawley JN, Penn DL, Silverstein S. Social cognition in schizophrenia: recommendations from the measurement and treatment research to improve cognition in schizophrenia new approaches conference. Schizophr Bull 2005; 31: 882-887.

San L, Cuidad A, Álvarez E, Bobes J, Gilaberte I. Symptomatic remission and social/vocational functioning in outpatients with schizophrenia: prevalence and associations in a cross-sectional study. Eur Psychiatry 2007; 22: 490-498.

Bellack AS, Sayers M, Mueser KT, Bennet M. Evaluation of social problem solving in schizophrenia. J Abnorm Psychol 1994; 103: 371-378.

Schmidt SJ, Mueller DR, Roder V. Social cognition as a mediator variable between neurocognition and functional outcome in schizophrenia: empirical review and new results by structural equation modelling. Schizophr Bull 2011; 37: 41-54.

Barch DM, Keefe RS. Anticipating DSM-V: opportunities and challenges for cognition and psychosis. Schizophr Bull 2010; 36: 43-47.

Heinrichs RW, Goldberg JO, Miles AA, McDermid Vaz S. Predictors of medication competence in schizophrenia patients. Psychiatry Res 2008; 157: 47-52.

Bowie CR, Harvey PD. Cognition in schizophrenia: impairments, determinants, and functional importance. Psychiatr Clin North Am 2005; 28: 613-633.

Buoli M, Caldiroli A, Panza G, Altamura AC. Prominent clinical dimension, duration of illness and treatment response in schizophrenia: a naturalistic study. Psychiatry Investig 2012; 9: 354-360.

Harvey P, Keefe R. Studies of cognitive change in patients in schizophrenia following novel antipsychotic treatment. Am J Psychiatry 2001; 158: 176-184.

Palmer B, Dawes S, Heaton R. What do we know about neuropsychological aspects of schizophrenia? Neuropsychol Rev 2009; 19: 365-384.

Amminger GP, Edwards J, Brewer WJ, Harrigan S, McGorry PD. Duration of untreated psychosis and cognitive deterioration in first-episode schizophrenia. Schizophr Res 2002; 54: 223-230.

Bruno N, Sachs N, Demily C, Franck N, Pacherie E. Delusions and metacognition in patients with schizophrenia. Cogn Neuropsychiatry 2012; 17: 1-18.

Liu SK, Hsieh MH, Huang TJ, Liu CM, Liu CC, Hua MS, Chen WJ, Hwu HG. Patterns and clinical correlates of neuropsychologic deficits in patients with schizophrenia. J Formos Med Assoc 2006; 105: 978-991.

Leeson VC, Harrison I, Ron MA, Barnes TR, Joyce EM. The effect of cannabis use and cognitive reserve on age at onset and psychosis outcomes in first-episode schizophrenia. Schizophr Bull 2012; 38: 873-880.

Ringen PA, Vaskinn A, Sundet K, Engh JA, Jónsdóttir H, Simonsen C, Friis S, Opjordsmoen S, Melle I, Andreassen OA. Opposite relationships between cannabis use and neurocognitive functioning in bipolar disorder and schizophrenia. Psychol Med 2010; 40: 1337-1347.

Rabin RA, Zakzanis KK, George TP. The effect of cannabis use on neurocognition in schizophrenia: a meta-analysis. Schizophr Res 2011; 128: 111-116.

Kerfoot KE, Rosenheck RA, Petrakis IL, Swartz MS, Keefe RS, McEvoy JP, Stroup TS; CATIE Investigators. Substance use and schizophrenia: adverse correlates in the CATIE study sample. Schizophr Res 2011; 132: 177-182.

Bowie CR, Serper MR, Riggio S, Harvey PD. Neurocognition, symptomatology, and functional skills in older alcohol-abusing schizophrenia patients. Schizophr Bull 2005; 31: 175-182.

Dillon C, Taragano F, Sarasola D, Iturry M, Serrano C, Raczkowski A, Allegri R. Cognitive performance in schizophrenia (paranoid vs residual subtype). Vertex 2007; 18: 170-175.

Hill SK, Ragland JD, Gur RC, Gur RE. Neuropsychological differences among empirically derived clinical subtypes of schizophrenia. Neuropsychology 2001; 15: 492-501.

Seltzer J, Conrad C, Cassens G. Neuropsychological profiles in schizophrenia: paranoid versus undifferentiated distinctions. Schizophr Res 1997; 23: 131-138.

Zalewski C, Johnson-Selfridge MT, Ohriner S, Zarrella K, Seltzer JC. A review of neuropsychological differences between paranoid and nonparanoid schizophrenia patients. Schizophr Bull 1998; 24: 127-145.

Bajs M, Janović S, Bajs M, Dordević V, Jevtović S, Radonić E, et al. Correlation of cognitive functions with some aspects of illness, treatment and social functioning in recurrently hospitalized schizophrenic patients. Coll Antropol 2011; 35: 39-44.

Lappin JM, Morgan KD, Morgan C, Dazzan P, Reichenberg A, Zanelli, et al. Duration of untreated psychosis and neuropsychological function in first episode psychosis. Schizophr Res 2007; 95: 103-110.

Basso MR, Nasrallah HA, Bornstein RA. Cognitive deficits distinguish patients with adolescent- and adult-onset schizophrenia. Neuropsychiatry Neuropsychol Behav Neurol 1997; 10: 107-112.

Ito S, Nemoto T, Tsujino N, Ohmuro N, Matsumoto K, Matsuoka H, Tanaka K, Nishiyama S, Suzuki, M., Kinoshita, H., Ozawa H, Fujita H, Shimodera S, Kishimoto T, Matsumoto K, Hasegawa T, Mizuno M. Differential impacts of duration of untreated psychosis (DUP) on cognitive function in first-episode schizophrenia according to mode of onset. Eur Psychiatry 2015; 30: 995-1001.

Linke M, Jankowski KS, Ciołkiewicz A, Jędrasik-Styła M, Parnowska D, Gruszka A, Denisiuk M, Jarema M, Wichniak A. Age or age at onset? Which of them really matters for neuro and social cognition in schizophrenia? Psychiatry Res 2015; 225: 197-201.

Rajji TK, Ismail Z, Mulsant H. Age at onset and cognition in schizophrenia: meta-analysis. Br J Psychiatry 2009; 195: 286-293.

Kravariti E, Morris RG, Rabe-Hesketh S, Murray RM, Frangou S. The Maudsley Early-Onset Schizophrenia Study: cognitive function in adolescent-onset schizophrenia. Schizophr Res 2003; 65: 95-103.

Jeste DV, Harris MJ, Krull A, Kuck J, McAdams LA, Heaton R. Clinical and neuropsychological characteristics of patients with late-onset schizophrenia. Am J Psychiatry 1995; 152: 722-730.

First MB, Williams JBW, Karg RS, Spitzer RL. Structured Clinical Interview for DSM-5 Disorders (SCID-5-CV). Washington DC: American Psychiatric Publishing; 2016.

Endicott J, Spitzer RL, Fleiss JL, Cohen J. The Global Assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 1976; 33: 766-771.

Addington D, Addington J, Schissel B. A depression rating scale for schizophrenics. Schizophr Res 1990; 3: 247-251.

Kay S, Fiszbein A, Opler L. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 261-276.

Opler MG, Yang LH, Caleo S, Alberti P. Statistical validation of the criteria for symptom remission in schizophrenia: preliminary findings. BMC Psychiatry 2007; 7: 35.

Anselmetti S, Poletti S, Ermoli E, Bechi M, Cappa S, Venneri A, Smeraldi E, Cavallaro R. The Brief Assessment of Cognition in Schizophrenia. Normative data for the Italian population. Neurol Sci 2008; 29: 85-92.

Keefe RS, Goldberg TE, Harvey PD, Gold JM, Poe MP, Coughenour L. The Brief Assessment of Cognition in Schizophrenia: reliability, sensitivity, and comparison with a standard neurocognitive battery. Schizophr Res 2004; 68: 283-297.

Sanders F, Smeets-Janssen MM, Meesters PD, van der Vlies AE, Kerssens CJ, Pijnenburg YA. Frontotemporal dementia and schizophrenia in later life: a comparison of executive and general cognitive functioning. Tijdschr Psychiatr 2012; 54: 409-417.

Torralva T, Roca M, Gleichgerrcht E, Bekinschte T, Manes F. A neuropsychological battery to detect specific executive and social cognitive impairments in early frontotemporal dementia. Brain 2009; 132: 1299-1309.

Burgess P. Development of a simplified version of the multiple errands test for use in hospital settings. Neuropsychol Rehabil 2002; 12: 231–255.

Manly T, Hawkins K, Evans J, Woldt K, Robertson IH. Rehabilitation of executive function: facilitation of effective goal management of complex tasks using periodic auditory alerts. Neuropsychologia 2002; 40: 271-281.

Bechara A, Tranel D, Damasio H. Characterization of the decision-making deficit of patients with ventromedial prefrontal cortex lesions. Brain 2000; 123: 2189-2202.

Baron-Cohen S, Wheelwright S, Hill J, Raste Y, Plumb I. The "Reading the Mind in the Eyes" Test revised version: a study with normal adults, and adults with Asperger syndrome or high-functioning autism. J Child Psychol Psychiatry 2001; 42: 241-251.

Serafin M, Surian L. Il test degli occhi: uno strumento per valutare la “teoria della mente”. Giornale Italiano di Psicopatologia 2004; 31: 213-236.

Stone VE, Cohen SB, Knight RT. Frontal lobe contribution to theory of mind. J Cogn Neurosci 1998; 10: 640–656.

Ekerholm M, Firus Waltersson S, Fagerberg T, Söderman E, Terenius L, Agartz I, Jönsson EG, Nyman H. Neurocognitive function in long-term treated schizophrenia: a five-year follow-up study. Psychiatry Res 2012; 200:144-152.

Green MF, Bearden CE, Cannon TD, Fiske AP, Hellemann GS, Horan WP, Kee K, Kern RS, Lee J, Sergi MJ, Subotnik KL, Sugar CA, Ventura J, Yee CM, Nuechterlein KH. Social cognition in schizophrenia, Part 1: performance across phase of illness. Schizophr Bull 2012; 38: 854-864.

Stober G, Ben-Shachar D, Cardon M, Falkai P, Fonteh AN, Gawlik M, Glenthoj BY, Grunblatt E, Jablensky A, Kim YK, Kornhuber J, McNeil TF, Muller N, Oranje B, Saito T, Saoud M, Schmitt A, Schwartz M, Thome J, Uzbekov M, Durany N, Riederer P. Schizophrenia: from the brain to peripheral markers. A consensus paper of the WFSBP task force on biological markers. World J Biol Psychiatry 2009; 10:127-155.

Remschmidt H, Theisen F. Early-onset schizophrenia. Neuropsychobiology 2012; 66: 63-69.

Arango C, Moreno C, Martínez S, Parellada M, Desco M, Moreno D, et al. Longitudinal brain changes in early-onset psychosis. Schizophr Bull 2008; 34: 341–353.

Arango C, Rapado-Castro M, Reig S, Castro-Fornieles J, González-Pinto A, et al. Progressive brain changes in children and adolescents with first-episode psychosis. Arch Gen Psychiatry 2012; 69: 16–26.

Mechelli A, Riecher-Rössler A, Meisenzahl EM, Tognin S, Wood SJ, Borgwardt SJ, et al. Neuroanatomical abnormalities that predate the onset of psychosis: a multicenter study. Arch Gen Psychiatry 2011; 68:489–495.

Reig S, Parellada M, Castro-Fornieles J, Janssen J, Moreno D, Baeza I, et al. Multicenter study of brain volume abnormalities in children and adolescent-onset psychosis. Schizophr Bull 2011; 37: 1270–1280.

Tang J, Liao Y, Zhou B, Tan C, Liu W, Wang D, et al. Decrease in temporal gyrus gray matter volume in first-episode, early onset schizophrenia: an MRI study. PLoS One 2012; 7: e40247.

Altamura AC, Buoli M, Serati M. Duration of illness and duration of untreated illness in relation to drug response in psychiatric disorders. Neuropsychiatry 2011; 1: 81-90.

Ochoa S, Usall J, Cobo J, Labad X, Kulkarni J. Gender differences in schizophrenia and first-episode psychosis: a comprehensive literature review. Schizophr Res Treatment 2012; 2012: 916198.

Zhang XY, Chen DC, Xiu MH, Yang FD, Haile CN, Kosten TA, et al. Gender differences in never-medicated first-episode schizophrenia and medicated chronic schizophrenia patients. J Clin Psychiatry 2012; 73: 1025-1033.

Karilampi U, Helldin L, Archer T. Cognition and global assessment of functioning in male and female outpatients with schizophrenia spectrum disorders. J Nerv Ment Dis 2011; 199: 445-448.

Yücel M, Bora E, Lubman DI, Solowij N, Brewer WJ, Cotton SM, et al. The impact of cannabis use on cognitive functioning in patients with schizophrenia: a meta-analysis of existing findings and new data in a first-episode sample. Schizophr Bull 2012; 38: 316-330.

Peer J, Bennett ME, Bellack AS. Neurocognitive characteristics of individuals with schizophrenia and cocaine dependence: comparison of currently dependent and remitted groups. J Nerv Ment Dis 2009; 197: 631-634.


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